The primary aim of these guidelines was to evaluate the role
of pharmacological agents in the treatment of adolescents with paraphilic
disorders who are also sexual offenders or at-risk of sexual offending.
Psychotherapeutic and psychosocial treatments were also reviewed. Adolescents
with paraphilic disorders specifically present a different therapeutic
challenge as compared to adults. In part, the challenge relates to adolescents
being in various stages of puberty and development, which may limit the use of
certain pharmacological agents due to their potential side effects. In
addition, most of the published treatment programmes have used cognitive
behavioural interventions, family therapies and psychoeducational
interventions. Psychological treatment is predicated in adolescents on the
notion that sexually deviant behaviour can be controlled by the offender, and
that more adaptive behaviours can be learned.
The main purposes of these guidelines are to
improve the quality of care and to aid physicians in their clinical decisions.
These guidelines brought together different expert views and involved an
extensive literature research. Each treatment recommendation was evaluated and
discussed with respect to the strength of evidence for efficacy, safety,
tolerability and feasibility. An algorithm is proposed for the treatment of
paraphilic disorders in adolescent sexual offenders or those who are at risk...
In
summary:
Psychosocial education was an unclear combination of CBT and education mainly
focused on sexual attitude and the improvement of victim empathy. Only four
studies (Hains et al., 1986; Graves et al.1992; Lab et al. 1993; Heran 2005) had comparison groups receiving non-specific treatment or a
waiting-list control group. Psychosocial education treatments were principally
delivered in peer group settings. In total, more than 500 male adolescent
sexual offenders (no females) were included in these programmes. Recidivism
rates were used as outcome measures in about half of studies, 8–20% recidivism
for sexual offences was observed depending on the duration of the follow-up (10
years when the recidivism rate was 20%). In the other studies different outcome
measures were used and cannot be compared except for victim empathy, which was
improved. Generally, due to the various and uncontrolled study designs used,
the results were not convincing...
In
summary: This combination of well-structured CBT and family
therapy seems very promising, especially for sexual offences but has only been
studied by one North American group. It needs to be replicated by other groups.
The studies were randomised and the comparison groups were using, in most
cases, CBT as usual, a hundred adolescents (mainly sexual offenders, including
three females) were receiving MST...
In
summary:
Psychosocial education was an unclear combination of CBT and education mainly
focused on sexual attitude and the improvement of victim empathy. Only four
studies (Hains et al., 1986; Graves et al.1992; Lab et al. 1993; Heran 2005) had comparison groups receiving non-specific treatment or a
waiting-list control group. Psychosocial education treatments were principally
delivered in peer group settings. In total, more than 500 male adolescent sexual
offenders (no females) were included in these programmes. Recidivism rates were
used as outcome measures in about half of studies, 8–20% recidivism for sexual
offences was observed depending on the duration of the follow-up (10 years when
the recidivism rate was 20%). In the other studies different outcome measures
were used and cannot be compared except for victim empathy, which was improved.
Generally, due to the various and uncontrolled study designs used, the results
were not convincing...
From this review we may conclude
that for the treatment of adolescent sexual offenders:
- overall, there is a low level of
scientific evidence;
- randomised controlled trials are
lacking, which can be attributed to the logistic, legal and ethical challenges
faced by researchers on such sensitive social issues (Långström et al. 2013);
- research focused on pharmacological
treatment is also lacking;
- the effectiveness of segregated
treatment units for juvenile sexual offenders has not been proven; however, it
is often necessary for the juvenile to be temporarily placed outside of his
family home when he has perpetrated against family members.
The study results indicate the
following useful trends:
- when pre- and post-evaluation is
available, it is in favour of the treatment group (as in adults), particularly
in juvenile sexual offenders at moderate risk of reoffending;
- drop outs of treatment programmes do
worse in the long term than sexual offenders who completed the programme (as in
adults);
- differences between “older” and
“younger” adolescents are suggested (Hunter and Goodwin, 1992);
- information concerning potential
adverse outcomes of treatment is not available;
- motivation for treatment is
generally not assessed. Due to the high rate of treatment non-compliance,
incorporating into pre-treatment and treatment programmes strategies that
minimise attrition may be helpful (Reitzel and Carbonell 2006).
In general, adjudicated youths are more motivated for treatment; and
- finally, the important roles that
caregiver discipline and youth association with deviant peers play in the
development and maintenance of antisocial behaviour have been supported
consistently by an extensive correlational and longitudinal literature (Loeber
& Farrington 1998)...
Full article at: http://goo.gl/FJauTf
a University Hospital Cochin, Faculty of Medicine Paris
Descartes, INSERM U 894 CPN, Paris,
France
b University of Ottawa, Institute of Mental Health Research,
Division of Forensic Psychiatry, Queen’s University, Clinical Director,
Forensic Treatment Unit, Brockville Mental Health Centre, Royal Ottawa Health
Care Group, Brockville, Ontario,
Canada
c Institute for Sex Research and Forensic Psychiatry, Center
for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
d East Psychiatry and Mental Health Department, University
of Chile, Clinica Las Condes, Chile
e Clinic for Child and Adolescent Psychiatry, University of
Medicine of Rostock, Rostock,
Germany
f University Forensic Centre (University Hospital of Antwerp),
Belgium
* Chair:
Florence Thibaut (France). Co-Chairs: John W. Bradford (Canada), Paul Cosyns
(Belgium). Secretary: Peer Briken (Germany). Members: Flora de la Barra
(Chile), Yesim Taneli (Turkey), Harvey Gordon (UK), Ariel Rosler (Israel), Elie
Witztum (Israel).
CONTACT Professor Florence Thibaut ; Email: rf.phpa@tuabiht.ecnerolf, University Hospital Cochin (site Tarnier), Department
of Psychiatry and Addictive disorders, 89 rue d’Assas, 75006Paris, France.
